Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion


  • Sandeepa H. S. Department of TB and Chest Disease, Akash Institute of Medical Sciences, Bengaluru, Karnataka, India
  • Narendra U. Department of TB and Chest Disease, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, Karnataka, India
  • Gajanan S. Gaude Department of TB and Chest Disease, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
  • Supriya Sandeepa Department of Pathology, Akash Institute of Medical Sciences, Bengaluru, Karnataka, India



Pigtail catheter, Residual pleural thickening, Streptokinase, Tuberculosis


Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was under

taken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.

Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.

Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36±0.49mm vs 9.28±1.50mm) (p <0.0001).

Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.


Light RW, Disorders of the pleura, mediastinum, diaphragm, and chest wall. In: Kasper, Braunwald, Fauci, Haucer, Lingo, Jameson, ed. Harrison's Principles Internal Medicine. 16th Edition, New York: McGraw Hill. 2005;1565-1568.

Light RW. Tuberculous pleural effusions. In: Light RW, Ed. Pleural Diseases. 4th Edition. Philadelphia. Lippincott Williams & Wilkins. 2001;182-195.

Ibrahim WH, Ghadban W, Khinji A. Does pleural tuberculosis disease pattern differ among developed and developing countries Respir Med. 2005;99:1038-45.

Baumann MH, Nolan R, Petrini M. Pleural tuberculosis in the United States: incidence and drug resistance. Chest. 2007;131:1125-32.

Sharma SK, Suresh V, Mohan A, Kaur P, Saha A, Kumar A, et al. A Prospective study of sensitivity and specificity of ADA estimation in the diagnosis of Tuberculosis pleural effusion. Ind J of Chest Dis and All Sci. 2001;43:149-55.

Single R. pulmonary Function Tests in patients of Tuberculous pleural effusion before, during and after treatment. Ind J Tub. 1995;42:33-41.

Seibert AF, Haynes J, Jr Middleton R, Jr Bass JB. Tuberculous pleural effusion. Twenty-year experience. Chest. 1991;99:883-6.

Berger HW, Mejia E. Tuberculous pleurisy. Chest. 1973;63:88-92.

Kwak SM, Park CS, Cho JH, Stein GH, Miyagi S. The effects of urokinase instillation therapy via percutaneous transthoracic catheter in loculated tuberculous effusion: a randomised prospective study. Yonsei Med J. 2004;45:822-8.

Ocaña I, Martinez-Vazquez JM, Segura RM, Fernandez-De-Sevilla T, Capdevila JA. Adenosine deaminase in pleural fluids: test for diagnosis of tuberculous pleural effusion. Chest. 1983;84(1):51-3.

Verma SK, Dubey AL, Singh PA, Tewerson SL, Sharma D. Adenosine Deaminase level in Tubercular pleural effusion. Lung ind. 2008;25:109-10.

Sulochana G, Khalifullah PA, Padmanabhan L. Adenosine Deaminase, Alpha 1 antitrypsin, Acid Glycoprotein, Ceruloplasmin and Protein in the diagnosis of Tuberculous pleural effusion. Ind J Chest Dis and All Sci. 1988;30:15-8.

Gupta PK, Suri JC, Goel A. Efficacy of Adenosine Deaminase in the diagnosis of pleural effusions. Ind J Chest Dis and All Sci. 1990;32:205-8.

Lai YF, Chao TY, Wang YH, Lin AS. Pigtail drainage in the treatment of tuberculous pleural effusions: a randomised study. Thorax. 2003;30:149-51.

Gammie JS, Banks MC, Fuhrman CR, Pham SM, Griffith BP, Keenan RJ et al. The Pigtail Catheter for Pleural Drainage: A Less Invasive Alternative to Tube Thoracostomy. JSLS. 1999;3:57-61.

Chin NK, Lim TK. Controlled trial of intrapleural streptokinase in the treatment of empyema and complicated pleural effusions. Chest. 1997;111:275-9.

Chung CL, Chen CH, Yeh CY, Sheu JR, Chang. Early and effective drainage in the treatment of loculated tubercular pleurisy. Eur Resp J. 2008;31:1261-7.






Original Research Articles